Paradoxical embolism in a boy with cystic fibrosis and a stroke

An 11 year old boy with cystic fibrosis suffered a stroke, producing right sided weakness. Four years previously a totally implantable venous access d evice (Port-a-Cath) had been inserted. Magnetic resonance angiography revea led a filling defect in the left middle cerebral artery. Transoesophageal e chocardiography demonstrated a thrombus attached to the tip of the Port-a-C ath and also the presence of a patent foramen ovale. After an initial perio d of anticoagulation the defect was closed using a septal occlusion device introduced via a cardiac catheter. The boy's neurological signs completely resolved and he remains free from further thromboembolic episodes. Whilst p ulmonary embolism has been described before in relation to a totally implan table venous access device, this is believed to be the first description of a paradoxical embolism in relation to such a device.